Research Items (32)
- Jan 2019
- Praxisleitfaden Entgelttransparenzgesetz
Nurses with effective clinical reasoning skills have a positive impact on patient outcomes. For this reason it is imperative that students understand and are able to demonstrate application of the clinical reasoning process. While clinical reasoning is often taught and assessed in preparation for clinical placements, a post-practicum assessment can help to identify if and to what extent students’ clinical experiences influence their learning. The aim of this chapter is to provide a detailed overview of the development of a post-practicum clinical reasoning exam, guidelines for educators interested in adopting this novel approach, and results from the initial evaluation of the exam.
- Jul 2018
The development of dementia-friendly communities underpins inclusion and enablement of individuals to live well with dementia in communities for as long as possible. A number of strategies are being developed that present communities with models of “how to” become dementia-friendly. Communities are unique, with varying demographics, strengths, and resources that support local action. Indeed, the most valuable first step in the process of building a dementia-friendly community may be a targeted conversation within the community itself. To this end, four unique Australian communities participated in facilitated workshops to explore their collective dementia knowledge, visions for the future, community strengths, and possible actions to promote dementia-friendly initiatives. The diversity of communities that attended confirms that no single model of dementia-friendly communities should be imposed. A consultative-transformative approach to planning may meet the needs of specific communities and will focus responsibility and reward for implementation at the local and individual level.
- Jun 2018
A supported community gardening program became appealing and therapeutically beneficial to people living with the impacts of dementia and their carers, despite not targeting either cohort specifically. This paper discusses how this program provides insights into the landscape of dementia inclusivity. The gardens involved were spaces that allowed positive risk-taking opportunities, respectful intersubjectivity and active citizenship. Our research findings indicate that a meaningful response to the rising incidence of dementia may be to build upon social and geographical attributes of community gardens. Understanding the multifaceted nature of a dementia inclusive landscape will enable authentic engagement and rights-based support for people living with the impacts of dementia.
- Apr 2018
Abstract Background Empathic concern has been found to decline in health professional students. Few effective educational programs and a lack of validated scales are reported. Previous analysis of the Empathic Concern scale of the Emotional Response Questionnaire has reported both one and two latent constructs. Aim To evaluate the impact of simulation on nursing students' empathic concern and test the psychometric properties of the Empathic Concern scale. Methods The study used a one group pre-test post-test design with a convenience sample of 460 nursing students. Empathic concern was measured pre-post simulation with the Empathic Concern scale. Factor Analysis was undertaken to investigate the structure of the scale. Results There was a statistically significant increase in Empathic Concern scores between pre-simulation 5.57 (SD = 1.04) and post-simulation 6.10 (SD = 0.95). Factor analysis of the Empathic Concern scale identified one latent dimension. Conclusion Immersive simulation may promote empathic concern. The Empathic Concern scale measured a single latent construct in this cohort. https://www.ncbi.nlm.nih.gov/pubmed/29698214
- Mar 2018
Clinical placements are specifically designed to facilitate authentic learning opportunities and are an integral component of undergraduate nursing programs. However, as academics and clinicians frequently point out, clinical placements are fraught with problems that are long-standing and multidimensional in nature. Collaborative placement models, grounded in a tripartite relationship between students, university staff and clinical partners, and designed to foster students' sense of belonging, have recently been implemented to address many of the challenges associated with clinical placements. In this study a qualitative descriptive design was undertaken with the aim of exploring 14 third year third year nursing students' perceptions of a collaborative clinical placement model undertaken in an Australian university. Students participated in audio recorded focus groups following their final clinical placement. Thematic analysis of the interview data resulted in identification of six main themes: Convenience and Camaraderie, Familiarity and Confidence, Welcomed and Wanted, Belongingness and Support, Employment, and The Need for Broader Clinical Experiences. The clinical collaborative model fostered a sense of familiarity for many of the participants and this led to belongingness, acceptance, confidence and meaningful learning experiences.
- Jan 2018
Aims and objectives: To evaluate the impact of an arts in health programme delivered by a specialised artist within an acute older person's unit. Background: Acute hospitals must meet the increasingly complex needs of older people who experience multiple comorbidities, often including cognitive impairment, either directly related to their admission or longer term conditions, including dementia. A focus on physical illness, efficiency and tasks within an acute care environment can all divert attention from the psychosocial well-being of patients. This focus also decreases capacity for person-centred approaches that acknowledge and value the older person, their life story, relationships and the care context. The importance of arts for health and wellness, including responsiveness to individual need, is well established: however, there is little evidence about its effectiveness for older people in acute hospital settings. We report on a collaborative arts in health programme on an acute medical ward for older people. Design: The qualitative study used collaborative enquiry underpinned by a constructivist approach to evaluate an arts programme that involved participatory art-making activities, customised music, song and illustration work, and enlivening the unit environment. Methods: Data sources included observation of art activities, semi-structured interviews with patients and family members, and focus groups with staff. Data were transcribed and thematically analysed using a line by line approach. Results: The programme had positive impacts for the environment, patients, families and staff. The environment exhibited changes as a result of programme outputs; patients and families were engaged and enjoyed activities that aided recovery from illness; and staff also enjoyed activities and importantly learnt new ways of working with patients. Conclusions: An acute care arts in health programme is a carefully nuanced programme where the skills of the arts health worker are critical to success. Utilising such skill, continued focus on person-centeredness and openness to creativity demonstrated positive impacts for patients, families, staff and the ward environment. Implications for practice: This study affirms the contribution of an arts in health program for older persons in an acute care setting in challenging the dominance of a task based medical model and emphasising person-centred care and outcomes.
- Aug 2017
Aim: To present findings from a study that explored nursing students' experiences of bullying in clinical and academic settings, the strategies used to negotiate bullying, and recommendations for empowering future students. Background: Nursing students are identified as a group who are at particular risk of bullying. Numerous studies have examined students' experiences of bullying in clinical contexts by qualified nurses, however, there has been far less attention to the bullying that occurs in academic settings where the perpetrators are university staff and other students. Design: The qualitative findings presented in this paper form one component of a mixed-methods, multi-site study that examined the nature and extent of bullying in one cohort of nursing students. Methods: A convenience sample of 29 first, second and third year undergraduate nursing students from one semi-metropolitan Australian university was recruited for semi-structured interviews in 2014. Interview data was analysed using NVivo. Findings: Participants described multiple examples of bullying occurring in both clinical and academic settings. Perpetrators included clinicians, facilitators, academics and fellow students. Bullying ranged from incivility to physical attacks. The impact of the bullying was profound; it caused many of the participants to feel anxious and distressed, it undermined their confidence and perception of competence, and often led them to question their career choice. Strategies described by participants to cope with or manage the bullying included avoidance, trying to 'just survive', and seeking support from trusted academic staff, family and friends. No episodes of bullying were formally reported. Conclusion: Bullying remains a pervasive phenomenon occurring in both clinical and academic settings. Students are, in many respects, a vulnerable and disempowered population who often fear the consequences of making a formal complaint. Thus, reporting structures and support strategies need to be re-examined, and resilience training is imperative. This article is protected by copyright. All rights reserved.
- Apr 2017
Aims and objectives: To examine nursing student placement preferences submitted as online comments to a university's placement management system, to inform strategies for positive residential aged care experiences. Background: There are predicted shortages of nurses to service an ageing population. Clinical placements undertaken by undergraduate nursing students help shape their attitudes and are a key determinant of career decision-making, yet there is little research about why students prefer particular placement areas. Design: Analysis of qualitative data from a placement management system. Methods: Of 6,610 comments received between 2007-2014, 607 related to aged care and were coded according to preferences for being placed in a residential aged care facility, with reasons for this preference thematically coded and quantified. Results: Four hundred and one comments (66.1%) related to students requesting not to be allocated residential aged care for the upcoming placement, primarily due to previous experience in the sector; 104 (17.1%) referred to aged care in a neutral manner, focusing on conflict of interest; 102 (16.8%) related to a request for an aged care placement. Conclusions: The student nurse comments characterise students as being focused on maximising their learning, while considering prior experience. In some cases, increased exposure to aged care is considered to offer limited learning opportunities, which is concerning and suggests that both the tertiary and aged care sectors have a joint responsibility to pursue recognition of aged care nursing as a specialised, highly skilled role. This article is protected by copyright. All rights reserved.
- Apr 2016
- Sixth International Nurse Education Conference
Nursing students are identified as a group at risk of bullying behaviours (Celik & Bayraktar, 2004; Randle, 2003), encompassing horizontal and vertical violence. Exposure has negative consequences for students, healthcare organisations, universities and profession as a whole (Cantey, 2013). Addressing such behaviours to date has focused on policy and procedure to support reporting and zero tolerance (Clarke et al, 2012). Undergraduates students (n=710) from an Australian university participated in an online survey, those who experienced bullying were invited to participate in a semi structured interview to explore their experience, response, and to identify strategies viewed as helpful for the future (n=35). Interviews were recorded, transcribed and thematically analysed guided by steps proposed by Braun and Clarke (2006). Four themes emerged. Get through the placement: students in clinical placement reported getting through the time and leaving as a means to manage. Just get out of there: students avoided offending individuals through a range of mechanisms including altering enrolments, placement choice, or seeking different peer groups. Don’t rock the boat: students recognised that behaviours were associated with poor culture including poor patient care but felt reporting or attempting to address the behaviours was futile. Wanting to know: students felt unprepared for behaviours of others. They wanted to know more about managing events, and assurance that action would be taken if reporting occurred. An inherent powerlessness was evident; students felt vulnerable in relation to success in undergraduate programs, yet felt they had ‘survived’. Although advice from clinical facilitators or academics was often sought, formal reporting of experiences was unlikely to occur. Participants suggested a range of strategies to prepare for, and make sense of bullying, including education and peer support. The findings challenge a reliance on policy and procedure, including reporting structures, as the means to address bullying, and suggest wider approaches be considered. Braun, V. & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology. 3(2), 77-101. Cantey, S. W. (2013). Recognizing and stopping the destruction of vertical violence. American Nurse Today, 8(2). Celik, S.S. & Bayraktar, N. (2004) A study of nursing student abuse in Turkey. Journal of Nursing Education, 43 (2), 330–336. Clarke, C. M., Kane, D. J., Rajacich, D. L., & Lafreniere, K. D. (2012). Bullying in undergraduate clinical nursing education. Journal of Nursing Education, 51(5), 269-276. Randle, J. (2003). Bullying in the nursing profession. Journal of Advanced Nursing, 43(4), 395-401.
- Dec 2015
Background: Clinical placement for students of nursing is a central component of tertiary nursing programs but continues to be a complex and multifaceted experience for all stakeholders. Objectives: This paper presents findings from a longitudinal 3-year study across multiple sites within the Australian context investigating the quality of clinical placements. Design: A study using cross-sectional survey. Settings: Acute care, aged care and subacute health care facilities. Participants: A total of 1121 Tasmanian undergraduate nursing students and 932 supervising ward nurses. Methods: Survey data were collected at completion of practicum from participating undergraduate students and supervising ward nurses across the domains of "welcome and belonging," "competence and confidence: reflections on learning," and "support for learning." In addition, free text comments were sought to further inform understandings of what constitutes quality clinical placements. Results: Overwhelmingly quantitative data demonstrate high-quality clinical placements are provided. Analysis of free text responses indicates further attention to the intersect between the student and the supervising ward nurse is required, including the differing expectations that each holds for the other. While meaningful interpersonal interactions are pivotal for learning, these seemingly concentrated on the relationship between student and their supervisor-the patient/client was not seen to be present. Conclusions: Meaningful learning occurs within an environment that facilitates mutual respect and shared expectations. The role the patient has in student learning was not made obvious in the results and therefore requires further investigation.
- Nov 2015
AimTo determine how nurses recognize and respond to unsafe practice. Background Practice guidelines and standards outline safe practice. Nurses face challenges in recognizing and responding unsafe practice. DesignWhittemore and Knafl's revised framework for integrative reviews guided the analysis. Data sourcesA comprehensive search of literature exploring the identification and response to unsafe practice, was undertaken in CINAHL, Medline, Embase and PsychoINFO databases for the period 2004-2014. Review methodsNineteen articles from 15 studies were included in the review. A mixed method integrative approach was used to review data and draw conclusions. ResultsBehaviours and cues that indicate unsafe practice are influenced by organizational and individual characteristics. Individual nurses responses are variable and there are professional and personal costs associated with being reported or reporting unsafe practice. Conclusion The small number of studies reviewed limits the conclusions that can be drawn from the review but suggest that nurses can identify unsafe practice in their peers. Individual nurses' recognition and response to unsafe practice in their peers contributes to patient outcomes and safety. Nurses need awareness training and strategies to respond to unsafe practice and reporting systems that protect reporters from repercussions. Further research investigating organizational factors and individual factors that contribute to a shift in practice across safety boundaries is required.
- Aug 2015
Decreasing the numbers of adverse health events experienced by people from culturally diverse backgrounds rests, in part, on the ability of education providers to provide quality learning experiences that support nursing students in developing cultural competence, an essential professional attribute. This paper reports on the implementation and evaluation of an immersive 3D cultural empathy simulation. The Satisfaction with Cultural Simulation Experience Scale used in this study was adapted and validated as the first stage of this study. Exploratory factor analysis and confirmatory factor analysis were undertaken to investigate the psychometric properties of the scale using two randomly-split sub-samples. Cronbach's Alpha was used to examine internal consistency reliability. Descriptive statistics were used for analysis of mean satisfaction scores and qualitative comments to open-ended questions were analysed and coded. A purposive sample (n = 497) of second of nursing students participated in the study. The overall Cronbach's alpha for the scale was 0.95 and each subscale demonstrated high internal consistency: 0.92; 0.92; 0.72 respectively. The mean satisfaction score was 4.64 (SD 0.51) out of a maximum of 5 indicating a high level of participant satisfaction with the simulation. Three factors emerged from qualitative analysis: "Becoming culturally competent", "Learning from the debrief" and "Reflecting on practice". The cultural simulation was highly regarded by students. Psychometric testing of the Satisfaction with Cultural Simulation Experience Scale demonstrated that it is a reliable instrument. However, there is room for improvement and further testing in other contexts is therefore recommended. Copyright © 2015 Elsevier Ltd. All rights reserved.
Supervision and support is central to sustainability of clinical placement experiences of undergraduate nurses, but open to influences that impact nurses' capacity to undertake the role. Whilst supervision of learners is integral to the role of health care professionals, the primary responsibility is to deliver safe and effective care. Supervision of learners in practice is impacted by low levels of organisational support, variable individual preparedness, and lack of feedback and recognition for the role from education and industry partners. Over a period of five years the Quality Clinical Placement Evaluation research team, consisting of a partnership between health care and tertiary sectors have developed, and utilised a practice development approach to understand and support the quality of clinical placement for undergraduates and supervising ward nurses involved in Tasmanian clinical placement programs. Importantly, the approach evolved over time to be a flexible three step program supporting the translation of findings to practice, comprised of an education session related to supervision support; survey distribution to undergraduates and supervising ward nurses following clinical placement; and workshops where stakeholders come together to consider findings of the survey, their experience and the local context, with resultant actions for change. This paper reports on findings from the program after successful implementation in urban tertiary hospitals as it was implemented in non-traditional clinical placement settings, including community, aged care and rural settings. Feedback from clinicians identifies the utility of the three step program across these settings. The unique partnerships and approach to evaluating, understanding and improving quality of clinical placements has potential for transferability to other areas, with the value of findings established for all stakeholders. Copyright © 2015 Elsevier Ltd. All rights reserved.
To determine the effect of immersive 3D cultural simulation on nursing students' empathy towards culturally and linguistically diverse patients. Accelerated globalisation has seen a significant increase in cultural diversity in most regions of the world over the past forty years. Clinical encounters that do not acknowledge cultural factors contribute to adverse patient outcomes and health care inequities for culturally and linguistically diverse people. Cultural empathy is an antecedent to cultural competence. Thus, appropriate educational strategies are needed to enhance nursing students' cultural empathy and the capacity to deliver culturally competent care. A one-group pretest, post-test design was used for this study. The simulation exposed students to an unfolding scene in a hospital ward of a developing county. A convenience sample of second-year undergraduate nursing students (n = 460) from a semi-metropolitan university in Australia were recruited for the study. Characteristics of the sample were summarised using descriptive statistics. T-tests were performed to analyse the differences between pre- and post simulation empathy scores using an eight item modified version of the Kiersma-Chen Empathy Scale. Students' empathy towards culturally and linguistically diverse patients significantly improved after exposure to the 3D simulation experience. The mean scores for the Perspective Taking and Valuing Affective Empathy subscales also increased significantly postsimulation. The immersive 3D simulation had a positive impact on nursing students' empathy levels in regards to culturally and linguistically diverse groups. Research with other cohorts and in other contexts is required to further explore the impact of this educational approach. Immersive cultural simulation experiences offer opportunities to enhance the cultural empathy of nursing students. This may in turn have a positive impact on their cultural competence and consequently the quality of care they provide to culturally and linguistically diverse patients. © 2015 John Wiley & Sons Ltd.
- Apr 2015
Nursing students' first clinical placement experience can be a critical turning point -reinforcing professional aspirations for some, and for others, a time of emotional turbulence. There is a paucity of research focusing on students' perceptions and concerns prior to their first placement experience. Thus, the aim of this study was to explore the concerns of first year bachelor of nursing students from one Australian university as they prepared for their first clinical placement. Participants completed an online 'readiness for practice' survey consisting of 22 items. This paper focuses on participants' responses to the one open ended question: 'Please comment on any concerns that you have in relation to being prepared for your first clinical placement'. Summative qualitative content analysis was used for analysis. 144 students (55%) responded to the open ended question. Responses were categorised into six themes including: Not prepared for placement; feeling nervous, anxious and worried; bullying and belonging; practicalities; patient safety and making mistakes; and working outside of my scope of practice. It appears that activities designed to equip students with the capacity to manage the inherent challenges of undertaking a clinical placement may sometimes have a paradoxical effect by increasing students' level of stress and anxiety. An enhanced understanding of students' concerns may help educators implement appropriate support strategies. Copyright © 2015. Published by Elsevier Ltd.
- Nov 2014
- 47th Australian Association of Gerontology National Conference: 50 Not Out Aiming for A Century
Background: Supporting quality clinical placements is central to workforce development and sustainability in the aged care workforce. This study explores the perceptions of key champions about their experiences in a program to facilitate health service transformation in four Teaching Aged Care Facilities. Method: A single time point qualitative design was employed to review participants’ experiences in a program to support excellence in multidisciplinary undergraduate clinical placements, as part of a whole of organisation change approach, designed to develop four Aged Care Facilities (ACFs) into learning organisations. Sixteen participants who were clinical nurse leaders (n=10) and academics (n=6) completed standardized semi-structured interviews. Qualitative data was coded for themes following an Interpretive Phenomenological Analysis. Results: Themes are presented in terms of barriers and enablers of clinical leadership for teaching and learning in ACFs. Several intra and inter personal factors were identified as essential for promoting adaptive clinical leadership for teaching and learning including the knowledge (expert in older adult care), attitudes (student centered) and skills (communication for interpersonal relationships, delegation abilities) of clinical nurse leaders. Organisational structures (regular meetings, line manager support) were considered essential to enhance a whole of organisation orientation to learning. Conclusion: Clinical leaders in aged care require an extensive knowledge base related to care of older persons. Yet this characteristic alone is not enough if we are to configure aged care leadership in ways that support a transition to foster more collegial relations typical of learning organisations. Critically, support from managers within institutions must translate into tangible support to develop requisite leader capacity and strategies to support others to engage. Implications: Excellence in clinical leadership in Aged Care is not reliant upon the leaders alone. Organisational structures that support and foster leaders’ influence can drive quality teaching and learning that is not only student-centred but promotes workforce capacity.
- Feb 2014
To develop and test the content and face validity, and reliability of the quality clinical placement evaluation tool. The importance of clinical experience during undergraduate nursing degrees is undisputed. To date, tools available to measure quality of clinical placements have focused on single perspectives, that of the undergraduate or that of the supervising nurse. The quality clinical placement evaluation tool was proposed to provide an assessment of clinical placement experiences informed by supervising ward nurses and undergraduate stakeholders. The study employed a cross-sectional design. The internal validity of an existing instrument was evaluated by an expert panel and modified for use in the acute care sector. Surveys were completed by undergraduate students (n = 48) and supervising ward nurses (n = 47). Factor analysis was used to identify themes drawn from the literature and explore redundancy of items. Reliability was assessed using Cronbach's alpha for internal consistency and test-retest (five to seven days apart). Reliability testing showed good internal consistency for the tool; test-retest reliability testing results were moderate to good for students and fair to moderate for nurses. Factor analysis identified three core themes related to supervising ward nurse responses that could also be applied to undergraduate nurses. The domains identified were the following: welcome and belonging; support to meet learning needs; and confidence and competence: reflections on learning. The quality clinical placement evaluation has shown statistically acceptable levels of reliability and validity for measuring the quality of clinical placement from perspectives of undergraduates and supervising ward nurses. The tool provides tertiary institutions, acute care facilities, wards and individuals with the means to capture views of the quality of clinical placement which can also be used to undertake comparisons over time and between sites.
- Jul 2013
Admission to hospital is recognised as a difficult time for children and families. This study explored clown doctor activities in an acute paediatric setting and the impact their activities have on children, their families, other health professionals and clown doctors themselves. We used observation, semi-structured interviews and focus groups with children and parents and staff and clown doctors and results provide a rich description of the work of clown doctors. The major themes were 'the encounter - in the moment' of the interaction of the child and the clown doctor and 'beyond the encounter'. The findings show that the impact of clown doctor visits is experienced beyond the immediate interaction, and this has not been clearly articulated in previous studies. This study highlights the multifaceted and complex nature of the work of the clown doctors and the high level of skill required as they modify and interpret play, activities and environment based on individual need and response.
- Mar 2013
Objective: The aim of the research was to evaluate a Preceptorship Workshop for nurses and midwives structured using a Practice Development framework. The workshop was underpinned by an exploration of nurses and midwives attitudes, perceptions and concerns about being a preceptor. Design: Emancipatory Practice Development guided this study. Setting: The study was conducted in a 400-bed tertiary referral hospital in an Australian state. Subjects: Ninety three nurses and midwives participated in the study. Main outcome measures: Data collection was undertaken from July - December 2009. Participants' completed a self-assessment of six identified learning outcomes on a five point Likert scale pre and post workshop. Findings were further informed by qualitative data collected during and following the workshops. Results: A paired samples t-test was used to compare pre and post workshop participant self ratings of knowledge, understanding and ability to apply preceptor skills. Statement four: 'My knowledge of the requirements of my role as a preceptor in relation to the structure of a range of nursing programs' demonstrates the highest shift in self assessment. There was a significant difference in the scores pre test (M= 3.04, SD=.751) and post test (M=3.99, SD=.617). Statistically significant changes occurred across all six learning outcomes, confirmed by qualitative findings from participant input on the day. Conclusion: Findings support the use of a Practice Development approach in the provision of a preceptor workshop, with clinicians indicating high acceptability that resulted in achievement of key learning outcomes.
- Oct 2012
Increasing rates of day surgery and decreasing length of hospital stay mean children's recovery from surgery extends beyond hospital and into the home. The objective of this study is to improve the understanding of experiences of children and their families during recovery at home post surgery. This is an exploratory, interpretive study using diaries and semi-structured interviews with children and parents. Results from this research show that children recovering at home after surgery have increased dependency and are likely to become the centre of family life; re-establishing independence is a marker of recovery. When present, pain dominates the experience. The families that go home ill-prepared experience high levels of worry. In conclusion, recovery from surgery is influenced by multiple factors; overall, families and children are resilient. There is a role for health professionals to tailor and improve information provision to parents and children about post-operative recovery, including assessment and management of pain. Information should be made available that describes the experience of other families who have undergone a similar surgery, and families should be made aware of what information they need and how to access it before and after discharge.
- Sep 2012
Achieving adoption, use, and integration of information and communication technology by healthcare clinicians in the workplace is recognized as a challenge that requires a multifaceted approach. This article explores community health nurses' engagement with information and communication technology as part of a larger research project that investigated the delivery of self-management support to people with chronic obstructive pulmonary disease. Following a survey of computer skills, participants were provided with computer training to support use of the project information system. Changes in practice were explored using action research meetings and individual semistructured interviews. Results highlight three domains that affected nurses' acceptance, utilization, and integration of information and communication technology into practice; environmental issues; factors in building capacity, confidence, and trust in the technology; and developing competence. Nurses face individual and practice challenges when attempting to integrate new processes into work activities, and the use of participatory models to support adoption is recommended.
Adoption and maintenance of healthy behaviours is pivotal to chronic disease self-management as this influences disease progression and impact. This qualitative study investigated health behaviour changes adopted by participants with moderate or severe chronic obstructive pulmonary disease (COPD) recruited to a randomised controlled study of telephone-delivered health-mentoring. Community nurses trained as health-mentors used a patient-centred approach with COPD patients recruited in general practice to facilitate behaviour change, using a framework of health behaviours; 'SNAPPS' Smoking, Nutrition, Alcohol, Physical activity, Psychosocial well-being, and Symptom management, through regular phone calls over 12 months. Semi-structured interviews in a purposive sample sought feedback on mentoring and behaviour changes adopted. Interviews were analysed using iterative thematic and interpretative content approaches by two investigators. Of 90 participants allocated to health-mentoring, 65 (72%) were invited for interview at 12-month follow up. The 44 interviewees, 75% with moderate COPD, had a median of 13 mentor contacts over 12 months, range 5-20. Interviewed participants (n=44, 55% male, 43% current smokers, 75% moderate COPD) were representative of the total group with a mean age 65 years while 82% had at least one additional co-morbid chronic condition. Telephone delivery was highly acceptable and enabled good rapport. Participants rated 'being listened to by a caring health professional' as very valuable. Three participant groups were identified by attitude to health behaviour change: 14 (32%) actively making changes; 18 (41%) open to and making some changes and 12 (27%) more resistant to change. COPD severity or current smoking status was not related to group category. Mentoring increased awareness of COPD effects, helping develop and personalise behaviour change strategies, even by those not actively making changes. Physical activity was targeted by 43 (98%) participants and smoking by 14 (74%) current smokers with 21% reporting quitting. Motivation to maintain changes was increased by mentor support. Telephone delivery of health-mentoring is feasible and acceptable to people with COPD in primary care. Health behaviours targeted by this population, mostly with moderate disease, were mainly physical activity and smoking reduction or cessation. Health-mentoring increased motivation and assisted people to develop strategies for making and sustaining beneficial change. ACTR12608000112368.
The growing burden of chronic disease will increase the role of primary care in supporting self-management and health behaviour change. This role could be undertaken to some extent by the increased practice nurse workforce that has occurred over recent years. Mixed methods were used to investigate the potential for general practice nurses to adopt this role during a 12-month randomised controlled study of telephone-delivered health mentoring in Tasmanian practices. Nurses (general practice and community health) were trained as health mentors to assist chronic obstructive pulmonary disease patients to identify and achieve personal health related goals through action plans. Of 21% of invited practices that responded, 19 were allocated to health mentoring; however, general practice nurses were unable to train as health mentors in 14 (74%), principally due to lack of financial compensation and/or workload pressure. For five general practice nurses trained as health mentors, their roles had previously included some chronic disease management, but training enhanced their understanding and skills of self-management approaches and increased the focus on patient partnership, prioritising patients' choices and achievability. Difficulties that led to early withdrawal of health mentors were competing demands, insufficient time availability, phone calls having lower priority than face-to-face interactions and changing employment. Skills gained were rated as valuable, applicable to all clinical practice and transferable to other health care settings. Although these results suggest that training can enhance general practice nurses' skills to deliver self-management support in chronic disease, there are significant system barriers that need to be addressed through funding models and organisational change.
- Nov 2011
This article is a report of a mixed method study of the quality of clinical placements for second year undergraduate nursing students in an acute care hospital. In response to the current and predicted workforce shortages, greater numbers of nursing undergraduate places are being offered at tertiary institutions. This means that requests for clinical places in hospitals to support undergraduate students has risen. Little is known about the impact of increased numbers on the quality of clinical placement as a learning experience and this is of concern as demand grows and the means of assessing capacity is still unknown. A 5-point Likert Scale questionnaire, including free text fields, was administered to undergraduates (n = 178), clinical facilitators (n = 22) and supervising ward nurses (n = 163) at two time points in 2009. The survey targeted the quality of the clinical placement in four domains: welcoming and belongingness; teaching and learning; feedback; confidence and competence. Findings. The findings demonstrated consistently high scoring of the clinical placement experience by both undergraduates and registered nurses. There were higher ratings of levels of support from clinical facilitators compared to supervising ward nurses evident in data associated with the items on the questionnaire relating to teaching and learning. The results are indicative of the professional commitment of nursing staff to support the next generation of nurses. The findings also give a mechanism to communicate outcomes of undergraduate support to nurses in practice, and highlight steps which can be taken to ensure high quality clinical placement continues.
- Jan 2011
Members of rural communities face the dual burden of high rates of cardiovascular disease and barriers to accessing cardiac rehabilitation programs (CRPs). While rural healthcare providers recognise the need for local delivery of such programs, they are constrained by funding and resource limitations. This research sought to explore the feasibility, acceptance and support for the delivery of a secondary prevention CRP in a rural community. Eight local participants were recruited to a pilot CRP following cardiac surgery, diagnosis of cardiovascular disease and/or identification by health practitioners as being at risk of developing cardiovascular disease. The key measures of success were the ability of the team to provide a program based on self-management principles, with a local and collaborative focus. The Health Education Impact Questionnaire (HeiQ) was used to measure the effectiveness and outcomes of the CRP. Qualitative data were also used in order to enhance understandings of the efficacy of CRPs in rural settings from the participant perspective. The delivery of a pilot program that engaged local healthcare providers in partnerships with local residents was successful. Local provision was clearly a positive aspect of the program. Participants described the program as supportive, holistic and convenient, providing new information in a framework that supported self-management. The program encouraged local collaboration that enabled continuation of the program. Local support from health professionals and participants provided strong motivation for attendance; however, the location of the program in a rural setting did not remove all travel barriers. Adhering to the principles of empowerment inherent in a self-management approach to rehabilitation meant accepting fluctuating attendance as individuals managed priorities in their lives.
This research paper examines the challenges in the development and adoption of an electronic patient diary within the Pathways Home for Respiratory Illness Project. This project supported community-based patients suffering from chronic obstructive pulmonary disease (COPD) to achieve increased levels of self-management and self-efficacy using electronic-monitoring techniques and mentoring by community health nurses. Participants had the option of voluntarily adopting an electronic patient diary to support their self-monitoring, which provided patients, nurses and clinicians with access to symptom and psycho-social data. This aimed to improve the identification, comprehension and initiation of early action in relation to alterations in their conditions. The paper presents data on technology adoption, electronic diary usage and, self-reported data quality, as well as examining the impact of the technology on hospitalisations (frequency and duration). The participants who chose to use the online patient diary continued their involvement with the project for the entire trial period (85% vs 54% completion). Participants were more likely to maintain use of the online patient diary than the paper diary. Both the groups experienced a positive improvement in their self-efficacy to self-manage their condition scores. The data highlight the problems implicit in some of the assumptions underpinning existing information systems models, especially in evaluating impact and the end-points presumed to be relevant in systems development life cycles.
- Jul 2008
Aims and objectives. To report on the process of transforming clinical practice amongst community nurses through a mentoring programme implemented to support self-management amongst community-based sufferers of chronic obstructive pulmonary disease. Background. The increasing incidence of and health burden from, chronic diseases has led to the emergence of more proactive, integrated chronic disease management approaches across the acute and primary care sectors. An important part of these approaches is the direct involvement of patients in their own care. Despite some difficulties with comparing the benefits of chronic disease self-management programmes, many evaluations report some benefit and all highlight the importance of health professionals in supporting self-management behaviours. In the primary care sector, community nurses are ideally situated to support these behaviours, but to do this effectively transformation of nursing practice must occur. Design. Qualitative, longitudinal study informed by action research methods and involving monthly group discussions with community nurse mentors. Methods. Community nurses from four community health centres in Tasmania were trained in motivational interviewing techniques to promote self-management amongst chronic obstructive pulmonary disease patients. Nurses’ mentoring experiences were monitored during group discussions and subjected to thematic analysis. Results. The paper reports the findings of the first 12 months of the project. In this phase, nurses experienced a transformation in their constructions of chronic obstructive pulmonary disease and their clinical practice. This involved a shift from a fatalistic, prescriptive, biomedical approach to a primary healthcare approach characterised by empathy, consultation, facilitation and a holistic focus. Conclusions. Community nurses face challenges in supporting chronic disease self-management. These challenges can be overcome and a transformation in clinical practice instilled. Relevance to clinical practice. This study highlights that it is possible to support community nurses to take a lead role in the ongoing management of chronic disease in the community.
- Jun 2006
While in past years there have been multiple attempts to address the issues surrounding the community/acute care interface, current outcomes suggest that few in Tasmania have achieved their goals for older people with chronic diseases, who continue to be high users of acute facilities. This presentation details the Pathways Home Chronic Respiratory Partnerships Project - a controlled study of a transferable, community-based program of self-management, supported by phone mentoring and patient symptom monitoring, compared with usual care. A multidisciplinary collaboration between the University of Tasmania's Schools of Medicine, Nursing, and Information Systems, the project focuses on those with respiratory conditions due to their high level of hospital presentations. The evaluative process ensures transferability to other chronic conditions. Aims: •Enhanced self-efficacy and quality of life for patients with chronic obstructive pulmonary disease (COPD) through interactions with mentors and use of a technology-supported system of self-management •Increased capacity for community health nurses (CHN's) to manage people with chronic disease by a shift in practice from a problem/task focus to facilitation of patient self management Method: Patients are: •Recruited while an inpatient •Provided with a CHN mentor following discharge •Asked to monitor and record daily symptoms in a paper diary, graduating to technological formats as able •Compared with usual care Yes Yes
This research-in-progress paper presents an examination of, and reflections on, the challenges of using information and communication technologies (ICTs) to support patients suffering chronic respiratory conditions to achieve increased levels of self-management and self-efficacy. These research insights arise as part of the planning and on-going implementation of the Pathways Home for Respiratory Illness project (Pathways). This project seeks to assist patients with either chronic obstructive pulmonary disease (COPD) or cystic fibrosis (CF) to acquire skills that empower them to comprehend and initiate action in relation to alterations in their conditions. The overall aim of Pathways is to evaluate the impact of these newly acquired skills for improving health outcomes at individual and population levels and is due for completion in 2008. Achieving benefits from the introduction of ICTs as part of processes aimed at building sustainable self-efficacy and self-management is very difficult, not least because of a desire to avoid simply replacing patient dependency on health professionals with dependency on technology. Reflections on the challenges and experiences within the project to-date illuminate some implicit assumptions underpinning existing IS models for evaluating impact in terms of adoption, usage and benefit and the end-points we presume in our system development processes.